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The Difficulties When Coronavirus Cases Flood U.S. Hospitals


Now let's continue this status report. People working inside emergency rooms include Dr. Craig Spencer. Years ago he served in West Africa during an Ebola outbreak. Now he is director of global health and emergency medicine at Columbia University Medical Center in New York City, which is considered the epicenter of this crisis right now. He joins us via Skype. Dr. Spencer, good morning.

CRAIG SPENCER: Good morning, Steve.

INSKEEP: What is each day like in the emergency room now?

SPENCER: I think the important message is that the empty streets of New York City - you may see images of an empty Time Square - they do not reflect the reality within hospitals at this moment. Once you walk into the ER, everyone is gowned-up in PPE, the harsh fluorescent lights reflecting off goggles. And it's - I've described it as a cacophony of coughing. This is something that's new for many of us. Not - in addition to the high number of really sick patients, many that are getting put on life support, we have to think about how we protect ourselves and how we take care of our colleagues. Like, how do we eat and drink when taking off that N95 mask feels so dangerous?


SPENCER: And how do we keep up with the constant protocol changes? Because we're learning so much every single day about how to provide the best quality care to our patients. So this is...

INSKEEP: You know, you just think about a basic thing, like the advice not to touch your face. Any time you take off the mask or put it back on, I guess you're touching your face.

SPENCER: Absolutely. The one thing I've been telling people is that we were told not to touch our face in West Africa, and it was nearly impossible as well. So everyone, give yourself a little slack if you still find yourself touching your face now in the era of coronavirus.

INSKEEP: OK. You've given us a phrase that's going to stick with me a little while - a cacophony of coughing in the emergency room, where you are periodically working. And we're not at the peak in New York, according to Governor Cuomo, Governor Andrew Cuomo. He expects the peak to come sometime in April. What is that going to mean for the hospital where you work?

SPENCER: For - I think for all hospitals in New York City, what we're seeing is this kind of backlog of patients. At the beginning of this, everyone tried their best to get hospital beds empty to make sure that there was room for all of the really sick patients that were coming in. We've done that, and a lot of places are starting to fill, especially ICU beds. There's obviously a lot of concern about personal protective equipment and ventilators.

I'm hoping that, you know, the USS Comfort (ph), the Navy ship, and all the other things that we've been doing to increase hospital bed capacity across the city is going to be enough because we were a little slow in getting started. I'm just hoping that it's enough to be able to provide the care that we need to for the continuing increase in cases here in New York City.

INSKEEP: Leila Fadel highlighted some of the numbers, that this is a question of math. Let me ask about this particular math problem. Do you have an issue that, even as the number of cases increases, the number of available medical personnel may be reduced because some get sick?

SPENCER: Absolutely. That's a big concern. We know that thousands of health care workers in China were infected. We know that up to 8% of Italy's infections were in health care workers. We're concerned about that. We know that it could have a big impact on our health care force. Thankfully, we already have some of our colleagues who have survived coronavirus and are hoping to be joining us again in the fight, in the front line. But it's something that worries us every day, absolutely.

INSKEEP: Bottom line - do you feel like New York is going to be OK, the New York hospital system is going to get through this?

SPENCER: I know that we're going to get through this. But quite honestly, my biggest concern is the rest of the country, for people who think this is a political or partisan issue and are not being prepared or taking this serious. And for me, the bigger issue is, really, the global impact. This is going to be worse in Mozambique than in Missouri. There's been such little discussion of that.

INSKEEP: Dr. Craig Spencer is in New York City. Thank you so much.

SPENCER: Thank you, Steve.

INSKEEP: So what can hospitals do in the time that remains before the peak reaches them? Dr. Ashish Jha is director of Harvard's Global Health Institute, and he joins us via Skype. Dr. Jha, good morning.

ASHISH JHA: Good morning, Steve.

INSKEEP: I just want to note that we've been hearing hopeful-sounding bits of news. There's a tent hospital opening in New York. That hospital ship is in place. Automakers are making ventilators. Brooks Brothers is making masks. That all sounds good, but is it enough?

JHA: Yeah, so, Steve, you know, we are so late to this. We had two months to prepare, and unfortunately, as a country, we didn't. And now I think we are doing a lot of things that we need to be doing. I still don't think we're doing it as seriously as we need to. And so when you ask is it enough, I think it's better than not acting at all, but I worry that in large parts of the country, as Dr. Spencer said, it won't be enough because too many people still are not taking it as seriously as they need to.

INSKEEP: Meaning that New York City at least is paying attention, but it could be that Cincinnati or - name your city. I don't want to wish tragedy on anybody, but other cities could be as hard-hit.

JHA: Yeah, so I think New York City is the canary in the coal mine, right? I think Governor Cuomo used that line, and I think that's correct. We are going to see this in city after city, and then we are going to see this in the suburbs and in the rural areas. It's just going to take longer to get to other places. And so if we see this through the lens of this is somehow just going to affect the big cities on the coast, I think a lot of places are going to get into a lot of trouble. And they may not have the resources that New York has to throw at this problem, and that's what I worry about.

INSKEEP: Is there some benefit in that the peak number of patients seems to be likely to arrive at different times in different places - it's not all happening right at once?

JHA: Absolutely, Steven. This is a place where - actually, this is one of the silver linings. And so I worry that we won't have enough staff and equipment for New York, but other cities and towns that don't have the crisis now can shift those resources to New York. And then when those places get hit, New York can shift resources. It will require federal coordination. It's going to be very hard for people to do this ad hoc. But one of the silver linings here is, because everybody is getting hit at a different time, we can actually expand the set of resources we have by sharing more effectively.

INSKEEP: You just gave us one possible strategy for getting through the next many months. Let me ask about another one. We heard Dr. Spencer talk about health care workers getting sick. Is there a potential advantage there in that if health care workers get sick and recover, you may end up with a core of health care workers who are immune for a while?

JHA: Yeah, absolutely. So again, our primary strategy should be to make sure that health care workers don't get sick. But as Dr. Spencer said, we saw large numbers of infections in China, in Italy. We're already starting to see them in American cities. Those people are going to be out of commission for a while. Some of them will end up getting very, very sick, and some of them will even die. More than 60 doctors have died in Italy. So our primary goal should be to keep people healthy.

But to the extent that people do get infected and get sick - and hopefully, most or all of them will recover - they actually are able to take care of other people without worrying about getting sick themselves.

INSKEEP: Very briefly, Dr. Deborah Birx at the White House the other day said a couple hundred thousand dead might be, like, a best-case scenario, if we do everything almost perfectly. Did you hear that and nod?

JHA: I heard that and I said, I think we can do better than that, but we've got to really work hard to make sure that we don't have hundreds of thousands of Americans dying. And I think we can, but we've got to take this very, very seriously.

INSKEEP: Dr. Jha, thank you so much.

JHA: Thank you, Steve.

INSKEEP: Dr. Ashish Jha is director of Harvard's Global Health Institute.

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.

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